Xicheng Deng

Cardiac papillary fibroelastoma (PFE) is rare in children, and large (>30 mm), mobile, right-sided PFEs are exceptionally uncommon. This report describes a 7-year-and-6-month-old patient who presented with upper respiratory tract infection and an incidental cardiac murmur. Transthoracic echocardiography revealed a 30 × 25 × 21 mm pedunculated, mobile mass on the anterior tricuspid valve leaflet. Differential diagnosis included thrombus, vegetation, and other cardiac tumors. Surgical excision with tricuspid valvuloplasty was performed due to embolization risk. Gross examination showed a cauliflower-like mass. The patient recovered uneventfully with preserved valve function. This case demonstrates that large, mobile right-sided PFEs can occur in asymptomatic children, and early surgical intervention with valve preservation is recommended to prevent embolic complications.

Background: Internet gaming disorder (IGD) is prevalent globally and linked to significant negative outcomes. Impoverished rural adolescents face unique risks due to limited supervision and unequal digital resources, with limited longitudinal research conducted in this population. Existing studies show sex differences in IGD prevalence, but their manifestations and mechanisms in rural populations remain unclear. Objective: This is the first large-sample cross-sectional and prospective cohort study targeting impoverished adolescents in rural areas. It aimed to determine the prevalence of IGD among impoverished rural adolescents, identify sex-specific risk and protective factors, and evaluate the longitudinal predictors of IGD. Methods: In this study, self-administered questionnaires were used to collect demographic characteristics, affective states, impulsivity, gaming time, and scores for IGD. First, the prevalence of IGD at baseline and follow-up, along with sex differences, was calculated. Correlation analysis was conducted to explore variables associated with IGD. Subsequently, multivariate logistic regression analysis was conducted to identify baseline and follow-up predictors of IGD. Results: The cross-sectional analysis at baseline included 13,931 valid responses (IGD prevalence: n=725, 5.2%; males: 489/7304, 6.7%; females: 236/6627, 3.6%). A 1-year longitudinal follow-up showed IGD prevalence of 5% (692/13,931; males: 511/7304, 7.0%; females: 181/6627, 2.7%; after multiple imputations). Common baseline factors were gaming time (females: odds ratio [OR] 1.11, 95% CI 1.08-1.14, P <.001; males: OR 1.11, 95% CI 1.09-1.13, P <.001), self-esteem scores (females: OR 0.95, 95% CI 0.92-0.98, P =.002; males: OR 0.95, 95% CI 0.92-0.97, P <.001), depression scores (females: OR 1.14, 95% CI 1.11-1.16, P <.001; males: OR 1.11, 95% CI 1.09-1.13, P <.001), and impulsive behavior (females: OR 1.16, 95% CI 1.10-1.22, P <.001; males: OR 1.10, 95% CI 1.06-1.14, P <.001). Companionship (OR 0.71, 95% CI 0.52-0.97; P =.03) was a protective factor for females, while age (OR 1.08, 95% CI 1.02-1.15; P =.02) and poor self-regulation (OR 1.07, 95% CI 1.03-1.11; P =.001) posed extra risk for males at baseline. Longitudinal predictors were baseline gaming time (females: OR 1.06, 95% CI 1.03-1.09, P <.001; males: OR 1.02, 95% CI 1.00-1.05, P =.03) and impulsive behavior (females: OR 1.38, 95% CI 1.30-1.46, P <.001; males: OR 1.27, 95% CI 1.22-1.31, P <.001). Baseline companionship (OR 0.32, 95% CI 0.23-0.43; P <.001) was a protective factor for females, while baseline poor self-regulation (OR 1.32, 95% CI 1.27-1.37; P <.001) was a predictive factor for males after 1 year. Conclusions: IGD prevalence was lower in rural than in urban populations and higher in males than in females. Impulsivity, gaming time, and guardian companionship showed sex differences: females relied more on companionship, whereas males were more vulnerable to poor self-regulation. Interventions should address these differences, strengthening family support and psychological adjustment. This study provides novel insights into sex-specific pathways of IGD in rural settings and offers empirical evidence for developing targeted prevention strategies, highlighting its practical significance for public health.

BACKGROUND Gaming disorder is prevalent in the world and poses significant harm. Poor rural adolescents face unique risks due to limited supervision and unequal digital resources, with limited longitudinal research. Existing studies show sex differences in its prevalence, but their manifestations and mechanisms in rural populations remain unclear. OBJECTIVE This study aims to determine the prevalence of gaming disorder among poor rural adolescents in China, identify sex-specific risk and protective factors, and evaluate longitudinal predictors of new-onset gaming disorder over a one-year follow-up period. METHODS A longitudinal study was conducted among poor rural students. Questionnaires collected demographics, psychological status, and gaming symptoms. Analyses included correlation analysis, followed by multivariate logistic regression to identify baseline associated factors and predict follow-up disorder. RESULTS Baseline included 13,931 valid responses (prevalence: 5.2%; males: 6.7%, females: 3.6%). A 1-year follow-up with 3,838 responses showed 5.6% prevalence (males: 7.8%, females: 3.4%). Common baseline factors: longer gaming time, lower self-esteem, higher depression, and greater impulsivity. Sex differences: companionship protected females; age and poor self-regulation posed extra risks for males. Follow-up predictors: baseline longer gaming time, lower self-esteem, and greater impulsivity. Sex differences: baseline companionship protected females; baseline poor self-regulation and disorder history predicted males. CONCLUSIONS Rural prevalence is lower than urban, with males higher than females. Depression, self-esteem, impulsivity, gaming duration, and caregiver companionship are key factors with sex differences: females rely more on companionship, while males are more vulnerable to poor self-regulation. Interventions should address these differences, strengthening family support and psychological adjustment.

Background: Double aortic arch (DAA) is a rare congenital vascular anomaly resulting in a complete vascular ring that encircles and compresses the trachea and esophagus, leading to respiratory and gastrointestinal symptoms. Accurate diagnosis and timely surgical intervention are essential for symptom relief and preventing complications. However, data on surgical outcomes and long-term follow-up are limited. This study retrospectively analyzed surgical outcomes and perioperative management of DAA to elucidate optimal diagnostic and therapeutic approaches.Method: A retrospective cohort study enrolled patients undergoing DAA repair (August 2015–May 2024). Participants were stratified into isolated DAA or DAA with associated intracardiac anomalies groups. Demographic, operative, and outcome variables were compared.Results: Among 10 patients undergoing double aortic arch repair, 6 comprised the isolated DAA group (3 males/3 females; mean age 3.70 ± 3.18 months; mean weight 6.28 ± 2.77 kg) and 4 had associated intracardiac anomalies (3 males/1 female; mean age 6.70 ± 6.12 months; mean weight 6.15 ± 3.59 kg). Isolated DAA patients and those with intracardiac anomalies showed no statistically significant differences in: symptom onset (28.17 ± 37.66d vs. 30.50 ± 41.96d), anatomic subtypes (dominant right arch 83% vs. 50%), extracardiac anomaly rates (50% vs. 75%), or clinical manifestations—respiratory (67% vs. 100%) and other systemic (17% vs. 75%) (all P > 0.05). All procedures were successfully completed with significantly shorter operative time in the isolated group (104.83 ± 22.23 vs. 233.25 ± 38.55 min, P < 0.001). No significant intergroup differences (P > 0.05) were observed in preoperative ventilation, blood loss, ventilator duration, Cardiac Intensive Care Unit stay, drainage duration, hospitalization, or complication rates. During mean 12.7-month follow-up (1–36 months), near-complete symptom resolution occurred in 9/10 survivors, with one death from respiratory failure in a comorbid patient 10 days post-discharge.Conclusion: Surgical repair of double aortic arch demonstrates acceptable safety and efficacy in both infants and children, with favorable short-to-midterm clinical outcomes regardless of concomitant intracardiac anomalies.

Objectives: This study aimed to investigate the clinical value of abdominal aortic spectral Doppler combined with echocardiography in the diagnosis of aortic coarctation in pediatric patients.Methods: Pediatric patients with aortic coarctation, diagnosed by computed tomography angiography (CTA) and surgically confirmed, were retrospectively enrolled. These patients were divided into two groups based on the availability of abdominal aortic spectral Doppler. Additionally, both abdominal aortic spectral Doppler and echocardiographic data were collected for the normal group. All data were compared and analyzed to determine the reasons for discrepancies in diagnostic results.Results: No significant differences were observed in baseline characteristics among the three groups (p > 0.05). There were statistically significant differences in aortic isthmus velocity and aortic isthmus Z-scores between the normal group and the two patient groups (p < 0.05), but there were no significant differences in aortic isthmus velocity or aortic isthmus Z-scores between the two patient groups (p > 0.05). The abdominal aortic spectral Doppler group demonstrated significantly decreased peak systolic velocity (PSV), prolonged acceleration time (AT), and reduced pulsatility index (PI) and resistance index (RI) compared with controls (p < 0.05). Echocardiographic detection rates differed between groups: non-abdominal aortic spectral Doppler group, 59 true-positive coarctation cases (sensitivity 85.5%, false-negative rate 14.5%); abdominal aortic spectral Doppler group, 75 true-positive cases (sensitivity 96.2%, false-negative rate 3.8%). The combined diagnostic model incorporating abdominal aortic PSV, AT, and aortic isthmus Z-score achieved superior performance (AUC = 0.98), significantly outperforming individual parameters.Conclusions: Abdominal aortic spectral Doppler combined with echocardiography can improve the diagnostic sensitivity of aortic coarctation in pediatric patients and can be used as an important indirect imaging approach in clinical practice to reduce missed diagnoses of aortic coarctation.

The right axillary thoracotomy, an alternative approach for selected open-heart procedures, offers aesthetic advantages. However, intercostal vessel injury is a potential postoperative complication that can lead to major bleeding. Herein, we report a case of postoperative active bleeding from intercostal vessel injury after right axillary thoracotomy for ventricular septal defect repair. Hemorrhage was successfully halted by compressing the suspected bleeding site with a Foley catheter inserted through the chest wall. This case demonstrates a simple management method of active intercostal vascular bleeding after cardiac operation. It may be an appropriate option in selected postoperative patients with a high index of suspicion of intercostal vascular bleeding after operation via a thoracotomy approach.

Objective: To retrospectively assess the outcomes of open-heart repair for ventricular septal defect in children using a right vertical axillary incision compared to median sternotomy.Method: From January 2022 to May 2023, children who underwent open-heart surgery for the repair of congenital ventricular septal defect in our department were selected for a propensity score-matched study. The propensity score matching method was utilized to pair children in the right vertical axillary incision group with those undergoing surgery via median sternotomy at a 1:1 ratio, based on age and weight.Results: There were 35 cases in each group. In the right vertical axillary incision group, the median age was 15 (7–40) months and the median weight was 8 (7–12) kg. In the median sternotomy group, the median age was 7 (3–37) months and the median weight was 7 (5–14) kg. The age (Z = −1.871, p = 0.061) and weight (Z = −1.462, p = 0.144) of the two groups showed no significant differences. The right vertical axillary incision group exhibited a significantly shorter incision length compared to the median sternotomy group (p < 0.001). Additionally, the median postoperative drainage was lower in the right vertical axillary incision group than in the median sternotomy group (p = 0.044), indicating statistical significance. No significant differences were observed between the groups concerning operation time (p = 0.565), bypass time (p = 0.855), cross-clamp time (p = 0.204), oxygenation index one hour post-surgery (p = 0.651), pleural effusion at 12 h post-surgery (p = 0.470), abnormal postoperative electrocardiogram (p = 0.452), cardiac intensive care unit duration (p = 0.211), or length of hospital stay (p = 0.095). The hospitalized children were followed up for 3 months to 1 year, during which there were no fatalities or complications.Conclusion: Open-heart repair of congenital ventricular septal defect through a right vertical axillary incision is a safe and effective surgical technique that minimizes surgical trauma and enhances aesthetic outcomes.

Background: Vacuum bell (VB) is a technique to treat pectus excavatum in children. Its effectiveness and influencing factors, however, remain under investigated. The aim of this study was to examine the therapeutic effect and its influencing factors of VB in children with pectus excavatum.Methods: A cross-sectional observational study was conducted. Parents of children with pectus excavatum who underwent treatment with a VB between January 2018 and December 2019 were recruited. A survey was designed based on previously related studies and delivered to the parents in September–October 2021. The therapeutic effect was analyzed using subjective experiences by parents. Factors related to effectiveness were analyzed through univariate analysis and multivariate logistic regression.Results: Of the 77 surveys distributed, 65 (84%) were returned. The mean duration of VB was 23.20 (SD 9.86) months. Caregivers rated the effect of VB treatment as moderate (41.5%), good (46.2%), excellent (12.3%). There were 39 children (60%) who had at least one pause of using VB for more than two weeks. Univariate analysis showed no significant difference between age, height, weight, duration of VB (months) and the effectiveness of VB therapy as defined by caregivers (p > 0.05) and significant difference were observed of the variables “complication of petechiae” (p = 0.034) and “device returned to manufacturer for repair” (p = 0.011). The multivariate logistic regression showed that the occurrence of complication petechiae (p = 0.046) was an influential factor for the effectiveness of VB.Conclusions: The evaluations reported by the parents suggested that the VB treatment was effective, although with varying degrees. The complication of petechiae seems an influencing factor to successful VB treatment in children with pectus excavatum. Further studies are needed to assess the long-term outcome and effect of VB and to improve the device and to reduce complications in order to enhance compliance and improve effectiveness.

Here we report a rare morphology of a cardiac fibroma in a child. A 2-year and 8-month-old toddler came for “chronic constipation” and was found to have a heart murmur on cardiac auscultation. Further transthoracic echocardiography suggested “a strong echogenic mass in the left ventricular wall, with some part of “a string of beads” in shape extending into left ventricle outflow tract”, which was atypical for either a tumor, thrombus or vegetation. The child underwent resection of the mass and mitral valvuloplasty. Pathological examination confirmed the mass as a cardiac fibroma.